Method and system of controlling conductive fluid flow during an electrosurgical procedure

ABSTRACT

Controlling conductive fluid flow during an electrosurgical procedure. At least some of the example embodiments are methods including: flowing conductive fluid from a source lumen to a suction lumen of an electrosurgical wand, the flowing with the electrosurgical wand in a first orientation; sensing a change in orientation of the electrosurgical wand to a second orientation different than the first orientation; and changing a control parameter associated with the conductive fluid flow, the changing responsive to the change in orientation of the electrosurgical wand.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/800,266 filed Mar. 13, 2013, now issued as U.S. Pat. No. 9,801,678the complete disclosure of which are incorporated herein by referencefor all purposes.

BACKGROUND

Electrosurgical procedures can be classified, at some level, based onthe location associated with the body at which the procedure takesplace. “Wet field” procedures generally take place inside the body, suchas within the shoulder or within the knee. “Dry field” proceduresgenerally take place on an outer surface of the body or surfaces exposedto atmosphere, such as the skin, within the mouth, or within thenasopharynx.

Regardless of whether a procedure is a wet field or dry field procedure,in most cases saline is delivered to the treatment site; however, in dryfield procedures excess saline can easily migrate and cause secondaryissues. For example, excess saline accumulating in the throat duringprocedures in the nose or mouth can cause unintended flow paths forelectrical current through the body, or may allow the saline to enterthe lungs.

Any advance that better controls saline fluid in and around theelectrodes of an electrosurgical system would provide a competitiveadvantage.

BRIEF DESCRIPTION OF THE DRAWINGS

For a detailed description of exemplary embodiments, reference will nowbe made to the accompanying drawings in which:

FIG. 1 shows an electrosurgical system in accordance with at least someembodiments;

FIG. 2 shows a perspective view a portion of a wand in accordance withat least some embodiments;

FIG. 3 shows an elevation view of a system in order to describeshortcomings of the related-art;

FIG. 4 shows an elevation view of a system in order to describeshortcomings of the related-art;

FIG. 5 shows an elevation view of a system in order to describeshortcomings of the related-art;

FIG. 6 shows an elevation view of a (partial) system in accordance withat least some embodiments;

FIG. 7 shows a schematic diagram of a flow control device in accordancewith at least some embodiments;

FIG. 8 shows a schematic diagram of a flow control device in accordancewith at least some embodiments;

FIG. 9 shows an electrical block diagram of an electrosurgicalcontroller in accordance with at least some embodiments;

FIG. 10 shows an elevation view of a (partial) system in accordance withat least some embodiments;

FIG. 11 shows an electrical block diagram of a flow control device inaccordance with at least some embodiments; and

FIG. 12 shows a method in accordance with at least some embodiments.

NOTATION AND NOMENCLATURE

Certain terms are used throughout the following description and claimsto refer to particular system components. As one skilled in the art willappreciate, companies that design and manufacture electrosurgicalsystems may refer to a component by different names. This document doesnot intend to distinguish between components that differ in name but notfunction.

In the following discussion and in the claims, the terms “including” and“comprising” are used in an open-ended fashion, and thus should beinterpreted to mean “including, but not limited to . . . .” Also, theterm “couple” or “couples” is intended to mean either an indirect ordirect connection. Thus, if a first device couples to a second device,that connection may be through a direct connection or through anindirect connection via other devices and connections.

Reference to a singular item includes the possibility that there areplural of the same items present. More specifically, as used herein andin the appended claims, the singular forms “a,” “an,” “said” and “the”include plural references unless the context clearly dictates otherwise.It is further noted that the claims may be drafted to exclude anyoptional element. As such, this statement serves as antecedent basis foruse of such exclusive terminology as “solely,” “only” and the like inconnection with the recitation of claim elements, or use of a “negative”limitation. Lastly, it is to be appreciated that unless definedotherwise, all technical and scientific terms used herein have the samemeaning as commonly understood by one of ordinary skill in the art towhich this invention belongs.

“Active electrode” shall mean an electrode of an electrosurgical wandwhich produces an electrically-induced tissue-altering effect whenbrought into contact with, or close proximity to, a tissue targeted fortreatment.

“Return electrode” shall mean an electrode of an electrosurgical wandwhich serves to provide a current flow return path with respect to anactive electrode, and/or an electrode of an electrical surgical wandwhich does not itself produce an electrically-induced tissue-alteringeffect on tissue targeted for treatment.

A fluid conduit said to be “within” an elongate housing shall includenot only a separate fluid conduit that physically resides within aninternal volume of the elongate housing, but also situations where theinternal volume of the elongate housing is itself the fluid conduit.

“Orientation”, with regard to an electrosurgical wand, shall meaninclination of the distal end of wand relative to the handle end of thewand, elevation of the distal end of the wand (e.g., relative to asource of conductive fluid), rotational orientation of the wand, or acombination thereof.

“Three-axis gyroscope” shall refer to a sensor that senses positionalchanges in position in all three spatial directions.

“Six-axis gyroscope” shall refer to a sensor that senses positionalchanges in position in all three spatial directions, and also sensesacceleration in all three spatial directions.

Where a range of values is provided, it is understood that everyintervening value, between the upper and lower limit of that range andany other stated or intervening value in that stated range isencompassed within the invention. Also, it is contemplated that anyoptional feature of the inventive variations described may be set forthand claimed independently, or in combination with any one or more of thefeatures described herein.

All existing subject matter mentioned herein (e.g., publications,patents, patent applications and hardware) is incorporated by referenceherein in its entirety except insofar as the subject matter may conflictwith that of the present invention (in which case what is present hereinshall prevail). The referenced items are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such material by virtue of prior invention.

DETAILED DESCRIPTION

Before the various embodiments are described in detail, it is to beunderstood that this invention is not limited to particular variationsset forth herein as various changes or modifications may be made, andequivalents may be substituted, without departing from the spirit andscope of the invention. As will be apparent to those of skill in the artupon reading this disclosure, each of the individual embodimentsdescribed and illustrated herein has discrete components and featureswhich may be readily separated from or combined with the features of anyof the other several embodiments without departing from the scope orspirit of the present invention. In addition, many modifications may bemade to adapt a particular situation, material, composition of matter,process, process act(s) or step(s) to the objective(s), spirit or scopeof the present invention. All such modifications are intended to bewithin the scope of the claims made herein.

FIG. 1 illustrates an electrosurgical system 100 in accordance with atleast some embodiments. In particular, the electrosurgical systemcomprises an electrosurgical wand 102 (hereinafter “wand”) coupled to anelectrosurgical controller 104 (hereinafter “controller”). The wand 102comprises an elongate housing 106 that defines distal end 108 where atleast some electrodes are disposed. The elongate housing 106 furtherdefines a handle or proximal end 110. The wand 102 further comprises aflexible multi-conductor cable 112 housing a plurality of electricaland/or communicative conductors (not specifically shown in FIG. 1), andthe flexible multi-conductor cable 112 terminates in a wand connector114. As shown in FIG. 1, the wand 102 couples to the controller 104,such as by a controller connector 120 on an outer surface 122 (in theillustrative case of FIG. 1, the front surface).

Though not visible in the view of FIG. 1, in some embodiments the wand102 has one or more internal fluid conduits coupled to externallyaccessible tubular members. As illustrated, the wand 102 has a firstflexible tubular member 116 and a second flexible tubular member 118. Insome embodiments, the flexible tubular member 116 is used to provide aconductive fluid (e.g., saline) to the distal end 108 of the wand. In anexample system, the flexible tubular member 116 is a hose or tubinghaving a 0.152 inch outside diameter, and a 0.108 inch inside diameter,but other sizes may be equivalently used. In the example system of FIG.1, the source of the conductive fluid is a saline bag 150, with thesaline flowing through an intermediate flow control device 152 prior toreaching the wand 102. The flow control strategy implemented by the flowcontrol device 152 is discussed in greater detail below. The flowcontrol device 152 comprises a flexible multi-conductor cable 154housing a plurality of electrical and/or communicative conductors (notspecifically shown in FIG. 1), and the flexible multi-conductor cable154 terminates in a connector 156. As shown in FIG. 1, the flow controldevice couples to the controller 104, such as by a controller connector158 on an outer surface 122 (in the illustrative case of FIG. 1, thefront surface). Thus, in the example system the electrosurgicalcontroller 104 communicatively couples to and controls operation of theflow control device 152.

In some embodiments, flexible tubular member 118 is used to providesuction for aspiration at the distal end 108 of the wand. The suctionfor aspiration may be provided from any suitable source (e.g., wallsuction in a hospital environment, or suction provided from aperistaltic pump). In one example system, the flexible tubular member118 is a hose having a 0.25 inch outside diameter, and a 0.17 inchinternal diameter, but other sizes may be equivalently used.

Still referring to FIG. 1, the controller 104 controllably providesenergy to the wand 102 for the electrosurgical procedures (discussedmore below). A display device or interface panel 124 is visible throughthe outer surface 122 of the controller 104, and in some embodiments auser may select operational modes of the controller 104 by way of theinterface device 124 and related buttons 126.

In some embodiments the electrosurgical system 100 also comprises a footpedal assembly 130. The foot pedal assembly 130 may comprise one or morepedal devices 132 and 134, a flexible multi-conductor cable 136 and apedal connector 138. While only two pedal devices 132, 134 are shown,one or more pedal devices may be implemented. The outer surface 122 ofthe controller 104 may comprise a corresponding connector 140 thatcouples to the pedal connector 138. The foot pedal assembly 130 may beused to control various aspects of the controller 104, such as theoperational mode. For example, a pedal device, such as pedal device 132,may be used for on-off control of the application of radio frequency(RF) energy to the wand 102. A second pedal device, such as pedal device134, may be used to control and/or set the operational mode of theelectrosurgical system. For example, actuation of pedal device 134 mayswitch between energy levels. In yet still further embodiments, the wand102 may further comprise switches accessible on an outside portion,where the switches may control the operational modes of the controller104.

The electrosurgical system 100 of the various embodiments may have avariety of operational modes. One such mode employs Coblation®technology. In particular, the assignee of the present disclosure is theowner of Coblation® technology. Coblation® technology involves theapplication of a RF energy between one or more active electrodes and oneor more return electrodes of the wand 102 to develop high electric fieldintensities in the vicinity of the target tissue. The electric fieldintensities may be sufficient to vaporize an electrically conductivefluid over at least a portion of the one or more active electrodes inthe region near the one or more active electrodes and the target tissue.Electrically conductive fluid may be inherently present in the body,such as blood, puss, or in some cases extracellular or intracellularfluid. In other embodiments, the electrically conductive fluid may be aliquid or gas, such as isotonic saline. In a particular embodiment ofwound treatment, the electrically conductive fluid is delivered in thevicinity of the active electrode and/or to the target site by the wand102, such as by way of the internal fluid conduit and flexible tubularmember 116.

When the electrically conductive fluid is heated to the point that theatoms of the fluid vaporize faster than the atoms recondense, a gas isformed. When sufficient energy is applied to the gas, the atoms collidewith each other causing a release of electrons in the process, and anionized gas or plasma is formed (the so-called “fourth state ofmatter”). Stated otherwise, plasmas may be formed by heating a gas andionizing the gas by driving an electric current through the gas, or bydirecting electromagnetic waves into the gas. The methods of plasmaformation give energy to free electrons in the plasma directly,electron-atom collisions liberate more electrons, and the processcascades until the desired degree of ionization is achieved. A morecomplete description of plasma can be found in Plasma Physics, by R. J.Goldston and P. H. Rutherford of the Plasma Physics Laboratory ofPrinceton University (1995), the complete disclosure of which isincorporated herein by reference.

As the density of the plasma becomes sufficiently low (i.e., less thanapproximately 1020 atoms/cm³ for aqueous solutions), the electron meanfree path increases such that subsequently injected electrons causeimpact ionization within the plasma. When the ionic particles in theplasma layer have sufficient energy (e.g., 3.5 electron-Volt (eV) to 5eV), collisions of the ionic particles with molecules that make up thetarget tissue break molecular bonds of the target tissue, dissociatingmolecules into free radicals which then combine into gaseous or liquidspecies. Often, the electrons in the plasma carry the electrical currentor absorb the electromagnetic waves and, therefore, are hotter than theionic particles. Thus, the electrons, which are carried away from thetarget tissue toward the active or return electrodes, carry most of theplasma's heat, enabling the ionic particles to break apart the targettissue molecules in a substantially non-thermal manner.

By means of the molecular dissociation (as opposed to thermalevaporation or carbonization), the target tissue is volumetricallyremoved through molecular dissociation of larger organic molecules intosmaller molecules and/or atoms, such as hydrogen, oxygen, oxides ofcarbon, hydrocarbons and nitrogen compounds. The molecular dissociationcompletely removes the tissue structure, as opposed to dehydrating thetissue material by the removal of liquid within the cells of the tissueand extracellular fluids, as occurs in related art electrosurgicaldesiccation and vaporization. A more detailed description of themolecular dissociation can be found in commonly assigned U.S. Pat. No.5,697,882, the complete disclosure of which is incorporated herein byreference.

In addition to the Coblation® mode, the electrosurgical system 100 ofFIG. 1 may also in particular situations be useful for sealing bloodvessels, when used in what is known as a coagulation mode. Thus, thesystem of FIG. 1 may have an ablation mode where RF energy at a firstvoltage is applied to one or more active electrodes sufficient to effectmolecular dissociation or disintegration of the tissue, and the systemof FIG. 1 may have a coagulation mode where RF energy at a second, lowervoltage is applied to one or more active electrodes sufficient to heat,shrink, seal, fuse, and/or achieve homeostasis of severed vessels withinthe tissue.

The energy density produced by electrosurgical system 100 at the distalend 108 of the wand 102 may be varied by adjusting a variety of factors,such as: the number of active electrodes; electrode size and spacing;electrode surface area; asperities and/or sharp edges on the electrodesurfaces; electrode materials; applied voltage; current limiting of oneor more electrodes (e.g., by placing an inductor in series with anelectrode); electrical conductivity of the fluid in contact with theelectrodes; density of the conductive fluid; and other factors.Accordingly, these factors can be manipulated to control the energylevel of the excited electrons. Since different tissue structures havedifferent molecular bonds, the electrosurgical system 100 may beconfigured to produce energy sufficient to break the molecular bonds ofcertain tissue but insufficient to break the molecular bonds of othertissue.

A more complete description of the various phenomena can be found incommonly assigned U.S. Pat. Nos. 6,355,032; 6,149,120 and 6,296,136, thecomplete disclosures of which are incorporated herein by reference.

FIG. 2 illustrates a perspective view of the distal end 108 of wand 102in accordance with an example system. In particular, in the examplesystem the wand 102 is a wound care wand enabled for use to treat woundson a patient's skin. Other types of wands may be used in the examplesystem. For example, the PROCISE® Max Plasma Wand available fromAthroCare Corporation of Austin, Tex., is designed and constructed foruse in the mouth and throat may be used, such as for tonsillectomies. Asa further example, wands designed in constructed for use in thenasopharynx may be used, such as for removal of portions of the softpalate and/or removal of polyps for treatment of sleep apnea. Therelative proportions of the components of wands designed for differenttreatments will differ, but regardless of size and proportion wands fordry field use will comprise the same base components: an activeelectrode; a return electrode; a source or discharge lumen from whichconductive fluid flows; and a suction or aspiration lumen in whichconductive fluid and ablated tissue is aspirated away from the treatmentsite.

The illustrative wand 102 of FIG. 2 has a suction lumen 200, two activeelectrodes 202 and 204, a support member 206, a source lumen 208, and areturn electrode 210. The support member 206 is coupled to the elongatehousing 106. In a particular embodiment, the elongate housing 106 andhandle 110 (FIG. 1) are made of a non-conductive plastic material, suchas polycarbonate. In yet other embodiments, the handle 110 and/orelongate housing 106 may be constructed in whole or in part of metallicmaterial, but the metallic material may be non-grounded and/or notprovide a return path for electrons to the controller 104. Further,support member 206 is a non-conductive material resistant to degradationwhen exposed to plasma. In some cases support member 206 is made of aceramic material (e.g., alumina ceramic), but other non-conductivematerials may be equivalently used (e.g., glass).

An illustrative two active electrodes 202 and 204 are coupled to thesupport member 206. Each active electrode is a metallic structure,around which plasma is created during use in some operational modes. Insome case, the wire is stainless steel, but other types of metallic wire(e.g., tungsten, molybdenum) may be equivalently used. As illustrated,each active electrode 202 and 204 is a loop of wire having a particulardiameter. In wands designed for other uses (e.g., ablation of tissue ofthe soft palate), the active electrode may take the form of a screen ormetallic plate with one or more apertures through the metallic plateleading to the suction lumen. Each example active electrode 202 and 204is electrically coupled to the controller 104 (FIG. 1). In some cases,the active electrodes 202 and 204 are coupled to the controller by wayof respective standoff portions and an insulated conductor (notspecifically shown) that runs through the elongate housing 106. Thus, byway of the cable 112 (FIG. 1) and electrical pins (shown and discussedbelow) in the connector 114 (FIG. 1), the active electrodes 202 and 204couple to the controller 104 (FIG. 1).

FIG. 2 further shows a source lumen 208. The source lumen 208 asillustrated is rectangular, where the long dimension is aligned with thewidth W. Rectangular shaped source lumen are merely illustrative, andany suitable shape may be equivalently used (e.g., circular, oval,square). The source lumen 208 is fluidly coupled within the elongatehousing 106 to flexible tubular member 116 (FIG. 1), through whichconductive fluids flow during use. Thus, during use, conductive fluidflows into the flexible tubular member 116 (FIG. 1), through one or morefluid conduits (not specifically shown) within the elongate housing 106,and out of the source lumen 208.

The distal end 108 of the example wand 102 further comprises a returnelectrode in the form of a conductive plate 210. In particular, theconductive plate 210 abuts the source lumen 208, and in the embodimentsof FIG. 2 a portion of the conductive plate 210 at least partiallydefines the outer aperture of the source lumen 208. The conductive plate210 is made of conductive material, which conductive material forms areturn path for electrical current associated with energy applied to theactive electrodes. In some cases the conductive plate 210 is made ofstainless steel, but other types of metals (e.g., tungsten, molybdenum)may be equivalently used. The illustrative conductive plate 210 isoriented such that at least some of the saline flowing through the fluidconduit 218 contacts the conductive plate 210 before contacting anadjacent wound or contacting the active electrodes 202 and 204.Conductive plate 210 is electrically coupled to the controller 104 (FIG.1). In some cases, the conductive plate 210 is coupled to the controllerby way of an insulated conductor (not specifically shown) that runsthrough the elongate housing 106. Thus, by way of the cable 112 (FIG. 1)and electrical pins in the connector 114 (FIG. 1), the conductive plate210 couples to the controller 104 (FIG. 1).

FIG. 2 also illustrates that a wand 102 in accordance with at least someembodiments further comprises a suction lumen 200. The suction lumen 200is fluidly coupled to the flexible tubular member 118 (FIG. 1) by way offluid conduit (not specifically shown) within the wand 102. Thus, and asthe name implies, the suction lumen 204 is used to remove byproducts ofwound treatment using the wand 102, such as removal of conductive fluid,molecularly disassociated tissue, and tissue separated from the woundbut otherwise still intact. In example operation of a wand for woundcare, aggressive aspiration is contemplated to enable removal of largerpieces of tissue not molecularly disassociated. In some cases, theaspiration may be created by an applied pressure between and including100 millimeters of mercury (mmHg) and 400 mmHg below atmospheric.

Some example wands for dry field procedures are designed and constructedsuch that the conductive fluid flow exits the source lumen, flows toand/or across the active electrode(s), and then is aspirated into thesuction lumen. In the example case of FIG. 2, the conductive plate 210has a lip portion on the distal end of plate that directs conductivefluid discharged from the source lumen 208 toward the active electrodes.A plasma may be created proximate the active electrodes during periodsof time when RF energy is applied to the active electrodes, and then theconductive fluid and ablation byproducts are aspirated into the suctionlumen 204. The specification now turns to shortcomings of related-artdevices.

The inventors of the present specification have found a shortcoming ofrelated-art devices in the form of variable conductive fluid flow basedon orientation of the wand. In the related-art, prior to performing thesurgical procedure the conductive fluid flow is manually adjusted, suchas by partially clamping the tubing member 116 (e.g., clamping using ahemostat). The adjustment involves setting a flow of conductive fluidout of the source lumen that is substantially aspirated back into thesuction lumen (i.e., no or very few drips of conductive fluid when thefluid is flowing out the source lumen). Once the flow of conductivefluid is set, the surgeon performs the procedure; however, an issuearises related to the orientation of the wand, which issue isillustrated with respect to FIGS. 3-5.

FIG. 3 shows an elevation view of a wand 102 with the tubing member 116coupled to a source of conductive fluid in the form of a saline bag 150.The remaining tubing and cables are not shown so as not to undulycomplicate the figure. Consider, for purposes of explanation, that priorto the surgical procedure the wand 102 is held in the orientation shownin FIG. 3, where the handle end 110 and the distal end 108 are atsubstantially the same elevation. Held in the orientation shown in FIG.3, a surgeon may adjust the flow of the conductive fluid (e.g., byadjusting the clamping force of hemostat 300) such that there are no orvery few drips of conductive fluid from the distal end of the wand 102(i.e., most if not all the conductive fluid flow is aspirated into thesuction lumen). In the orientation shown in FIG. 3, a certain amount ofpressure of conductive fluid exists related to the relative elevationbetween the distal end 108 of the wand and the fluid level in the salinebag 150, as shown by relative height H.

Now consider that during use the surgeon changes the inclination of thedistal end 108 in relation to the handle end 110. Stated another way,consider that the elevation of the distal end 108 changes such that therelative height H changes. FIG. 4 shows an elevation view of wand 102with the tubing member 116 coupled to a source of conductive fluid inthe form of a saline bag 150, but where the orientation of the distalend 108 has changed in relation to the handle end 110. In particular, inFIG. 4 the inclination of the wand 102 has changed such that the distalend 108 is lower than the handle end 110 (with the handle end held at aconstant elevation), and in so doing the relative height H has increased(considered against the FIG. 3). Given the static restriction to flowillustrated by the hemostat 300, the change in relative height H resultsin greater conductive fluid flow out of the source lumen at the distalend 108 of wand. The greater conductive fluid flow may result inunintended pooling of conductive fluid, which may have several adverseconsequences, such as unintended current paths for the flow ofelectrical current, and conductive fluid accumulating in undesirablelocations like the lungs.

Now consider that during use, the surgeon changes the orientation of thedistal end 108 in relation to the handle end 110 as shown in FIG. 5.FIG. 5 shows an elevation view of wand 102 with the tubing member 116coupled to a source of conductive fluid in the form of a saline bag 150,but where inclination of the wand 102 has changed such that the distalend 108 is higher than the handle end 110, and in so doing the relativeheight H has decreased. Again, given the static restriction to flowillustrated by the hemostat 300, the change in relative height H (ascompared to either FIG. 3 or FIG. 4) results in less conductive fluidflow out of the source lumen at the distal end 108 of wand. Lessconductive fluid flow may also result in inadequate wetting of theactive electrodes, and thus inefficient ablation or arterial sealing.

In some example systems, the length L of the wand 102 measured from thehandle end 110 to the distal end 108 may be six to eight inches. Itfollows that, even holding the handle end 110 at a constant elevation,the change in elevation of the distal end 108 caused by the change ininclination as between FIGS. 4 and 5 could be significant, on the orderof 12-16 inches. Moreover, in use the surgeon may not hold the handleend 110 at a constant elevation relative to the fluid level in thesaline bag 150, resulting in further changes in relative height H, eachof which results in a change in conductive fluid flow.

In accordance with the various embodiments, the issues associated withchanges in conductive fluid flow based on changes in relative height Hare addressed, at least in part, by a system and related method whichsenses changes in orientation of the wand 102, and automatically (i.e.,without human involvement at the time of the change) compensates fororientation changes of the wand 102 and/or changes in elevation of thewand 102 (even if orientation remains constant).

FIG. 6 shows an elevation view of wand 102 with the tubing member 116coupled to a source of conductive fluid in the form of a saline bag 150,but also additional devices to implement in the various exampleembodiments. In particular, FIG. 6 shows, in partial cutaway, that wand102 in accordance with example systems comprises an orientation sensor600. Orientation sensor 600 mechanically couples to the wand (and asshown mechanically couples within an interior volume 602 defined by thewand). Moreover, the orientation sensor 600 communicatively couples tothe controller 104, such as by way of conductors 604 (which conductorsmay reside within the multi-conductor cable 112 of FIG. 1). As the nameimplies, the orientation sensor 600 senses orientation of the wand 102.The orientation sensor 600 may take many suitable forms, examples ofwhich are discussed more thoroughly below. The example system of FIG. 6further comprises flow control device 152 which, in the example system,is likewise coupled to the controller 104. In accordance with variousembodiments, the flow control device 152 is coupled to the tubing member116 between the source of conductive fluid (in this example saline bag150) and the wand 102. The flow control device is designed andconstructed to present different restrictions to the flow of conductivefluid based on the orientation of the wand as sensed by the orientationsensor 600.

In accordance with the various embodiments, the surgeon holds the wandin a particular orientation, and sets the flow rate of the conductivefluid such that there are no or very few drips of conductive fluid fromthe distal end 108 of the wand 102 (i.e., most if not all the conductivefluid flow is aspirated into the suction lumen). Setting the flow maytake many forms. In some example systems, the flow may be set oradjusted by the surgeon interfacing with controller 104, such as bypushing buttons 126. In these example systems, interaction with thecontroller 104 sends a signal to the flow control device to raise orlower the flow allowed to pass through the flow control device. In othercases, the flow may be set by the surgeon interfacing with an interfacedevice 606 on the flow control device 152 itself. For example, theinterface device 606 may be a knob that when rotated in a firstdirection increases the flow of conductive fluid, and when rotated in asecond direction decreases the flow the conductive fluid.

Once the initial conductive fluid flow is set (and regardless of themechanism by which the initial flow is set), the surgeon may begin touse the wand in the electrosurgical procedure, and in using the wand 102the orientation of the distal end 108 may change. However, theorientation sensor 600 and flow control device 152 (and in some systemsthe controller 104) work together to control the flow of conductivefluid to reduce the effects of changes in pressure of conductive fluidcaused by changes in orientation of the wand 102. For example, if thedistal end 108 of the wand 102 is lowered, the relative height Hincreases which would tend to increase pressure and therefore increaseconductive fluid flow; however, sensing the lowering of the distal end108 of the wand 102 by way of the orientation sensor 600, the systemincreases flow restriction presented by the flow control device suchthat conductive fluid flow remains substantially constant. Oppositely,if the distal end 108 of the wand 102 is raised, the relative height Hdecreases which would tend to decrease pressure and therefore decreaseconductive fluid flow; however, sensing the raising of the distal end108 of the wand 102 by way of the orientation sensor 600, the systemdecreases flow restriction presented by the flow control device suchthat conductive fluid flow remains substantially constant.

In yet still other example systems, the control of flow implemented as afunction of orientation of the wand may implement orientation specificflow control strategies that differ. For example, if the orientationsensor 600 provides an indication that the distal end 108 is lower thanthe handle end 110, the system may reduce flow of conductive fluid (ascompared to the initial setting) as in the distal-end low orientationgravity may cause increased loss of conductive fluid. Oppositely, if theorientation sensor 600 provides an indication that the distal end 108 ishigher than the handle end 110, the system may increase flow ofconductive fluid (as compared to the initial setting) as in thedistal-end high orientation the effects of gravity may decrease thelikelihood of loss of conductive fluid.

Some orientation sensors may be able to sense rotational orientation ofthe wand 102, and implement rotational-orientation specific flow controlstrategies. For example, if the system senses that the wand isrotationally-oriented such that source lumen 208 is above the activeelectrodes and suction lumen, in such an orientation gravity assists theflow toward the suction lumen and thus the system may increaseconductive fluid flow. Oppositely, if the system senses that the wand isrotationally-oriented such that source lumen 208 is below the activeelectrodes and suction lumen 200, in such an orientation gravity worksagainst flow toward the suction lumen and thus the system may decreaseconductive fluid flow to reduce the likelihood of loss of conductivefluid. The rotational-orientation changes may be implemented in additionto, or in place of, inclination and/or elevation based control of theconductive fluid flow.

The orientation sensor may take many forms. In some example systems theorientation sensor 600 is an inclinometer that provides and analog ordigital value indicative of the relative positions of the handle end 110and the distal end 108. For example, part number ADIS16209 DigitalInclinometer and Accelerometer available from Analog Device ofEnglewood, Colo., may be used as inclinometer. However, using aninclinometer as the orientation sensor 600 may not provide the abilityto sense elevation changes (with constant inclination) or senserotational orientation changes. Thus, in other example systems theorientation sensor 600 may be implemented with a digital gyroscope, suchas a part number ITG-3050 Integrated Triple-Axis Digital-OutputGyroscope available from InvenSense, Inc. of Sunnyvale, Calif. Using athree-axis gyroscope the system may be able to sense not only changes ininclination of the wand 102, but also sense changes in elevation of thewand 102—that is, sense changes in all three spatial directions.Gyroscopes, whether digital or physical, are slow to “settle” and thushave limitations as to accuracy that reduce with continued measurementtime, but where the time frame may span several seconds. Thus, in yetstill further embodiments the orientation sensor 600 may be a six-axisgyroscope. “Six-axis” gyroscope is a term of art referring to a devicethat implements a three-axis gyroscope, as well as a correspondingthree-axis accelerometer. By combining the readings of the gyroscope andaccelerometer, more accurate measurements of orientation may beprovided. Thus, in yet still other systems the orientation sensor 600may be a six-axis gyroscope, such as a part no. MPU-6000/6050 Six-AxisMEMS Motion Tracking Device available from InvenSense, Inc.

FIG. 7 shows, in schematic form, an example flow control device 152 ingreater detail. In particular, the flow control device 152 comprises afirst connector 700 which is designed and constructed to fluidly coupleto a tubing member, such as an upstream portion of tubing member 116coupled to a saline bag 150 (not shown in FIG. 7). Any suitableconnector or connection system may be used, such as a barbed connector,or any of a variety of snap together “quick connectors”. Likewise, theflow control device has a second connector 702 which is designed andconstructed to fluidly couple to a tubing member, such as the downstreamportion of tubing member 116 coupled to a wand 102 (not shown in FIG.7). Between the illustrative connectors 700 and 702 resides a valve 704.Valve 704 has a stem 706, and position of the stem 706 (e.g., rotationalposition, elevational position) controls the restriction to conductivefluid flow presented by the valve 704. Example valve 704 furthercomprises an automatic valve operator 708 which enables selectivepositioning of the valve stem 706 based communicative signals receivedover the conductors 710, in example systems the conductors 710communicatively coupled to the controller 104. Thus, by sending signalsalong the conductors 710, the controller 104 may control the restrictionto conductive fluid flow presented by the valve 704. In the examplesystem of FIG. 7, the stem 706 position may also be manually adjustedbased on manipulation of knob 712 (e.g., when making the initial settingof the conductive fluid flow). In other cases, however, the initialsetting of conductive fluid flow is controlled electronically by thecontroller 104 and valve operator 704. In some example systems, the flowcontrol device 152 may define an outer cover 720 (dashed lines) whichdefines an internal volume 722 within which the valve 704 resides.However, in other cases the outer cover 720 may be fully or partiallyomitted.

FIG. 8 shows, in schematic form, a flow control device 152 in accordancewith other embodiments. In particular, the flow control device 152comprises a first connector 800 which is designed and constructed tofluidly couple to a tubing member, such as an upstream portion of tubingmember 116 coupled to a saline bag 150 (not shown in FIG. 8). Anysuitable connector or connection system may be used, such as a barbedconnector, or any of a variety of snap together “quick connectors”.Likewise, the flow control device has a second connector 802 which isdesigned and constructed to fluidly couple to a tubing member, such asthe downstream portion of tubing member 116 coupled to a wand 102 (notshown in FIG. 8). Between the illustrative connectors 800 and 802resides a valve 804 in the form a pinch valve. That is, the valve 804provides the selective control of restriction to conductive fluid flowby selectively “pinching” the tubing. Valve 804 has a stem 806, andposition the stem 806 relative to the backing member 808 controls therestriction to conductive fluid flow presented by the valve 804. Examplevalve 804 further comprises an automatic valve operator 810 whichenables selective positioning of the valve stem 806 based communicativesignals received over the conductors 812, in example systems theconductors 812 communicatively coupled to the controller 104. Thus, bysending signals along the conductors 812, the controller 104 may controlthe restriction to conductive fluid flow presented by the valve 804. Inthe example system of FIG. 8, the stem 806 position may also be manuallyadjusted based on manipulation of feature 814 (e.g., when making theinitial setting of the conductive fluid flow). In other cases, however,the initial setting of conductive fluid flow is controlledelectronically by the controller 104 and valve operator 810. As before,the flow control device 152 may define an outer cover 820 (dashed lines)which defines an internal volume 822 within which the valve 804 resides.However, in other cases the outer cover 820 may be fully or partiallyomitted.

FIG. 9 illustrates a controller 104 in accordance with at least someembodiments. In particular, FIG. 9 illustrates the controller 104coupled to the wand 102, where the wand 102 is shown in simplified formcomprising the active electrodes 202/204, the conductive plate 210acting as a return electrode, electrical leads coupled to the controller104, and the orientation sensor 600. The controller 104 comprises aprocessor 900. The processor 900 may be a microcontroller, and thereforethe microcontroller may be integral with random access memory (RAM) 902,read-only memory (ROM) 904, digital-to-analog converter (D/A) 906,digital outputs (D/O) 908 and digital inputs (D/I) 910. The processor900 may further provide one or more externally available peripheralbusses, such as a serial bus (e.g., I²C), parallel bus, or other bus andcorresponding communication mode. The processor 900 may further beintegral with a communication logic 912 to enable the processor 900 tocommunicate with external devices (such as the orientation sensor 600),as well as internal devices, such as display deice 124. Although in someembodiments the controller 104 may implement a microcontroller, in yetother embodiments the processor 900 may be implemented as a standalonecentral processing unit in combination with individual RAM, ROM,communication, D/A, D/O and D/I devices, as well as communication porthardware for communication to peripheral components.

ROM 904 stores instructions executable by the processor 900. Inparticular, the ROM 904 may store a software program that implements thevarious embodiments of controlling flow control device 152 based onorientation of the wand 102 as read from the orientation sensor 600, aswell as controlling the voltage generator 816 and interfacing with theuser by way of the display device 124 and/or the foot pedal assembly 130(FIG. 1). The RAM 902 may be the working memory for the processor 900,where data may be temporarily stored and from which instructions may beexecuted. Processor 900 couples to other devices within the controller104 by way of the D/A converter 906 (e.g., the voltage generator 916),digital outputs 908 (e.g., the voltage generator 916), digital inputs910 (i.e., push button switches 126, and the foot pedal assembly 130(FIG. 1)), and other peripheral devices.

Voltage generator 916 generates selectable alternating current (AC)voltages that are applied to the electrodes of the wand 102. In variousembodiments, the voltage generator defines two terminals 924 and 926.The terminals 924 and 926 may couple to active electrodes and returnelectrodes. As an example, terminal 924 couples to illustrative activeelectrodes 202 and 204, and terminal 926 couples to the conductive plate210 acting as return electrode. In accordance with the variousembodiments, the voltage generator generates an alternating current (AC)voltage across the terminals 924 and 926. In at least some embodimentsthe voltage generator 916 is electrically “floated” from the balance ofthe supply power in the controller 104, and thus the voltage onterminals 924, 926, when measured with respect to the earth ground orcommon (e.g., common 928) within the controller 104, may or may not showa voltage difference even when the voltage generator 916 is active. Adescription of one suitable voltage generator 916 can be found incommonly assigned U.S. Pat. Nos. 6,142,992 and 6,235,020, the completedisclosure of both patents are incorporated herein by reference for allpurposes.

In some embodiments, the various operational modes of the voltagegenerator 916 may be controlled by way of digital-to-analog converter906. That is, for example, the processor 900 may control the outputvoltage by providing a variable voltage to the voltage generator 916,where the voltage provided is proportional to the voltage generated bythe voltage generator 916. In other embodiments, the processor 900 maycommunicate with the voltage generator by way of one or more digitaloutput signals from the digital output 908 device, or by way of packetbased communications using the communication device 912 (connection notspecifically shown so as not to unduly complicate FIG. 9).

Still referring to FIG. 9, the orientation sensor 600 communicativelycouples to the processor 900 by way of conductors 604 through connector120. In an example system, male electrical pins 950 and 952 in connector114 couple to female electrical pins 954 and 956 in connector 120, andthus by plugging connector 114 in to the connector 120, electricalconnection is made. Within the controller 104 the communicativeconnections couple to the processor 900. There are a variety ofcommunicative coupling scenarios possible with respect to processor 900and orientation sensor 600, which depend in part on the type oforientation sensor used. For example, in some cases the communicationfrom the orientation sensor may be by way of an analog signal, in whichcase the system would comprise electrical connection to ananalog-to-digital input (not specifically shown). In other cases, thecommunication between the orientation sensor 600 and the processor 900may be a digital serial communication, in which case the system wouldcomprise electrical connection to the communication logic 912. So as notto unduly complicate the figure, the signals from the orientation sensorare shown only to couple to the processor 900. Regardless of how theprocessor 900 and orientation sensor 600 are communicatively coupled, byreading the orientation information from the orientation sensor 600 theprocessor 900, executing a program, may control the restriction to flowpresented by the flow control device.

The flow control device 152 (not shown in FIG. 9) communicativelycouples to the processor 900 by way of conductors 970 through connector158. In an example system, male electrical pins 972 and 974 in connector156 couple to female electrical pins 976 and 978 in connector 158, andthus by plugging connector 156 in to the connector 158, electricalconnection is made. Within the controller 104 the communicativeconnections couple to the processor 900. There are a variety ofcommunicative coupling scenarios possible with respect to processor 900and flow control device 152, which depend in part on the type of flowcontrol device 152. For example, in some cases the communication fromthe processor 900 may be by way of an analog signal, in which case thesystem would comprise electrical connection to the digital-to-analogmodule 906. In other cases, the communication between the processor 900and the flow control device 152 may be a digital serial communication,in which case the system would comprise electrical connection to thecommunication logic 912. So as not to unduly complicate the figure, thesignals from the flow control device are shown only to couple to theprocessor 900. Nevertheless, by sending signals to the flow controldevice the processor 900, executing a program, may control therestriction to flow presented by the flow control device.

The example systems discussed to this point have assumed that thecontroller 104 is directly responsible for reading orientationinformation from the orientation sensor 600 and commanding the flowcontrol device 152 to change the restriction to the flow of conductivefluid. However, in yet still other example embodiment the adjustments toconductive fluid flow may be controlled logically outside the controller104. FIG. 10 shows an elevation view of a system in accordance with yetstill further embodiments. In particular, in the example system of FIG.10 the flow control device 1000 is a standalone device that is directlycommunicatively coupled to the orientation sensor 600 by waymulti-conductor cable 1002. The electrical coupling of the wand 102 tothe controller 104 would still be present, but is not shown in FIG. 10so as not to unduly complicate the figure. Moreover, the wand 102 willlikewise still couple to a source of vacuum, but again such is not shownso as not to unduly complicate the figure.

Operation of the example system of FIG. 10 is similar to the previousembodiments. When a change in orientation (e.g., inclination, elevation,rotational-orientation) of the wand 102 is sensed, the flow controldevice 1000 may change the restriction to flow of conductive fluid tokeep the flow substantially the same in spite of the orientation change,or to implement a predetermined flow strategy based on the orientation.All the example methods discussed above (and below) are applicable tothe example system of FIG. 10.

FIG. 11 shows a schematic diagram of flow control device 1000 inaccordance with example systems. In particular, flow control device 1000comprises a valve 1100 of similar design, construction, and operation asdiscussed with respect to FIG. 8. For that reason, the operation of thevalve 1100 will not be discussed again here in detail. While a “pinch”type valve is shown, a valve such as shown in FIG. 7 may be equivalentlyused. Similarly, flow control device 1000 comprises connectors 1102 and1104 associated with the tubing, where the connectors are similar tothose discussed in FIGS. 7 and 8, and so will not be discussed againhere. However, the flow control device 1000 of FIG. 11 also comprises acomputer system comprising a processor 1106 coupled to a memory 1108(e.g., RAM memory) and also coupled to a long term storage device 1110(e.g., ROM, battery backed RAM, flash memory). The long term storagedevice 1110 may store programs that are copied to the memory 1108 andexecuted by the processor 1106, including programs to implement thevarious embodiments disclosed herein. Also coupled to the processor 1106in an input/output (I/O) device 1112, which I/O device 1112 enables theprocessor to be communicatively coupled to the valve operator of valve1100, as well as to be communicatively coupled to the orientation sensor600 in the wand 102. The precise nature of the I/O device 1112 dependson the communication system by which the valve operator and orientationsensor communicate (e.g., analog signals, parallel digital signals,serial digital communications). It is noted that the different I/Odevices may be used as between the valve operator and the orientationsensor.

The example flow control device 1000 further comprises a power supply1120 which may supply power to all the devices of the flow controldevice that need power. The electrical connections between the powersupply 1120 and the remaining components of the flow control device 1000are not shown so as not to unduly complicate the figure. In some examplesystems, the power supply 1120 is a battery or battery system. In othercases, the power supply 1120 takes power from a standard wall socket,and coverts the energy into a correct format for the various devices ofthe flow control device 1000 (e.g, converts 120 VAC from the wall socketto 3.3 VDC for the electronic components, and 12 VDC for valve operator1150). In the example system standalone system, operational power forthe orientation sensor 600 may be provided from the flow control device1000.

FIG. 12 shows a method in accordance with at least some embodiments,portions of which may be implemented by software executing on aprocessor. In particular, the method starts (block 1200) and comprises:flowing conductive fluid from a source lumen to a suction lumen of anelectrosurgical wand, the flowing with the electrosurgical wand in afirst orientation (block 1202); sensing a change in orientation of theelectrosurgical wand to a second orientation different than the firstorientation (block 1204); and changing a control parameter associatedwith the conductive fluid flow, the changing responsive to the change inorientation of the electrosurgical wand (block 1206). Thereafter, themethods ends (block 1208), likely to be immediately repeated whenorientation of the wand again changes.

From the description provided herein, those skilled in the art arereadily able to combine software created as described with appropriategeneral-purpose or special-purpose computer hardware to create acomputer system and/or computer sub-components in accordance with thevarious embodiments, to create a computer system and/or computersub-components for carrying out the methods of the various embodimentsand/or to create a non-transitory computer-readable medium (i.e., not acarrier wave) that stores a software program to implement the methodaspects of the various embodiments.

While preferred embodiments of this disclosure have been shown anddescribed, modifications thereof can be made by one skilled in the artwithout departing from the scope or teaching herein. The embodimentsdescribed herein are exemplary only and are not limiting. Because manyvarying and different embodiments may be made within the scope of thepresent inventive concept, including equivalent structures, materials,or methods hereafter though of, and because many modifications may bemade in the embodiments herein detailed in accordance with thedescriptive requirements of the law, it is to be understood that thedetails herein are to be interpreted as illustrative and not in alimiting sense.

What is claimed is:
 1. A system comprising: an electrosurgicalcontroller, the electrosurgical controller configured to produce radiofrequency (RF) energy at an active terminal with respect to a returnterminal; an electrosurgical wand coupled to the electrosurgicalcontroller, the electrosurgical wand having: an orientation sensor,readings from the orientation sensor indicative of orientation of afirst portion of the wand relative to a second portion of the wand,different than the first portion; an active electrode defined on adistal end of the electrosurgical wand; a lumen in operationalrelationship to the active electrode, the lumen coupled to tubing, thetubing and lumen configured to flow an electrically conductive fluidtherethrough; and a flow control device coupled to the tubing, the flowcontrol device operatively coupled to the orientation sensor; whereinthe system is configured to sense a change of orientation of the wand,and responsive to the change of orientation change a control parameterassociated with the flow control device, wherein the flow control deviceadjusts a flow of fluid at a first flowrate through the lumen if thewand is orientated such that the lumen is disposed above the activeelectrode, and adjusts a flow of fluid at a second flowrate, differentfrom the first flowrate, upon the wand being rotated such that the lumenis disposed below the active electrode.
 2. The system of claim 1 whereinthe orientation sensor is at least one selected from the groupconsisting of: an inclinometer; a gyroscope; a three-axis gyroscope; asix-axis gyroscope.
 3. The system of claim 1 wherein the flow controldevice is a pump operatively coupled with the tubing.
 4. The system ofclaim 1 further comprising: wherein the orientation sensor iscommunicatively coupled to the electrosurgical controller; wherein theflow control device is operatively coupled to the electrosurgicalcontroller; and wherein the electrosurgical controller is configured todetermine orientation of the electrosurgical wand and change a controlparameter of the flow control device.
 5. The system of claim 1 whereinthe system is configured to sense a change of orientation of the wand,and responsive to the change of orientation change a control parameterof the flow control device so as to compensate for changes of quantityof electrically conductive fluid flow adjacent the active electrode as aresult of changes of orientation.
 6. The system of claim 1 wherein thesystem is configured to generate an ionized vapor adjacent the activeelectrode and wherein changing the control parameter of the system isconfigured to form a more uniform ionized vapor as the wand orientationchanges.
 7. The system of claim 1 wherein the orientation sensor sensesrotational orientation of the wand.
 8. The system of claim 1 wherein thesystem restricts the flow of fluid at a first limit if the wand isorientated such that the lumen is disposed above the active electrodeand wherein the system restricts the flow of fluid at a second limit,different from the first limit, upon the wand being rotated such thatthe lumen is disposed below the active electrode.
 9. The system of claim1 wherein the system is configured to coagulate tissue adjacent theactive electrode and wherein the change in control parameter of the flowcontrol device is configured to maintain efficient coagulation as thewand orientation changes.
 10. A system comprising: an electrosurgicalcontroller, the electrosurgical controller configured to produce radiofrequency (RF) energy at an active terminal with respect to returnterminal; an electrosurgical wand coupled to the electrosurgicalcontroller, the electrosurgical wand comprising: an orientation sensor,readings from the orientation sensor indicative of elevation of a firstportion of the wand relative to a second portion of the wand, differentthan the first portion; an active electrode defined on a distal end ofthe electrosurgical wand; a lumen adjacent to the active electrode, thelumen coupled to tubing, wherein the tubing and lumen are configured toflow an electrically conductive fluid therethrough; and a flow controldevice coupled to the tubing, operatively coupled to the orientationsensor; wherein the system is configured to sense a change of elevationof the wand, and responsive to the change of elevation, change a controlparameter of the flow control device; and wherein the system isconfigured to vaporize the electrically conductive fluid adjacent theactive electrode sufficient to ablate tissue and wherein changing thecontrol parameter is configured to maintain efficient vaporization asthe wand elevation changes.
 11. The system of claim 10 wherein theorientation sensor readings indicate a relative location of the lumenrelative to the active electrode.
 12. The system of claim 10 wherein thesystem is configured to change a control parameter associated with theflow control device responsive to the change of elevation, wherein theflow control device adjust a flow of fluid at a first flowrate throughthe lumen if the wand is orientated such that the lumen is disposedabove the active electrode and adjusts a flow of fluid at a secondflowrate, different from the first flowrate, such that the lumen isdisposed below the active electrode.
 13. The system of claim 10 whereinthe orientation sensor is at least one selected from the groupconsisting of: an inclinometer; a gyroscope; a three-axis gyroscope; asix-axis gyroscope.
 14. The system of claim 10 wherein the flow controldevice is a pump coupled within the tubing.
 15. The system of claim 10further comprising: wherein the orientation sensor is communicativelycoupled to the electrosurgical controller; wherein the flow controldevice is operatively coupled to the electrosurgical controller; andwherein the electrosurgical controller is configured to determineelevation of the electrosurgical wand and change the control parameterof the flow control device.
 16. The system of claim 10 wherein thesystem is configured to change a control parameter of the flow controldevice to as to compensate for changes of fluid flow adjacent the activeelectrode as a result of changes in elevation.
 17. The system of claim10 wherein the orientation sensor is disposed within an interior volumeof a handle of the wand.
 18. The system of claim 10 wherein the systemis configured to coagulate tissue adjacent the active electrode andwherein the change in control parameter of the flow control device isconfigured to maintain efficient coagulation as the wand elevationchanges.